The Association of the COVID-19 Pandemic with the Uptake of Colorectal Cancer Screening Varies by Socioeconomic Status in Flanders, Belgium.

Objectives: To assess the association of the COVID-19 pandemic with an uptake rate and screening interval between two screening rounds in colorectal cancer screening program (CRCSP) and identify the disproportionate correlation of socioeconomic status (SES) factors.

Methods: An analysis was performed on aggregated screening and SES data at the area level in Flanders, Belgium, during 2018-2022. The screening uptake rate was the percentage of people returning self-test results within 40 days after invitation, and the screening interval was the number of days between current and previous screening. Differences in uptake rate and screening interval before and during COVID-19 were categorized into 10 quantiles, and determinants were evaluated using quantile regression models.

Results: Significant change was seen from March to August 2020. The areas with the greatest decrease in uptake rate and screening interval had low population density, and areas with the greatest increase in screening interval had the highest income and percentage of home ownership. In regression analysis, more people living alone (β = -0.09), lower income (β = 0.10), and a higher percentage of home ownership (β = -0.06) were associated with a greater decrease in uptake rate. Areas with lower population density (β = -0.75), fewer people of Belgian nationality (β = -0.11), and higher income (β = 0.42) showed greater increases in screening interval.

Conclusions: During the COVID-19 pandemic, people in areas with low SES were less likely to participate in screening, whereas people in areas with high SES were more likely to delay participation. A tailored invitation highlighting benefits of CRCSP is needed for people with low SES to improve uptake. Timely warnings could help people who delay participation adhere to screening intervals.